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Adrenal surgery in England: better outcomes in high‐volume practices
Author(s) -
Palazzo Fausto,
Dickinson Andrew,
Phillips Barbara,
Sahdev Anju,
Bliss Richard,
Rasheed Ashraf,
Krukowski Zygmunt,
NewellPrice John
Publication year - 2016
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13021
Subject(s) - medicine , endocrinology
Summary Aims and Background Adrenal surgery is performed by a variety of surgical specialities in differing environments and volumes. International data suggest that there is a correlation between adrenal surgery volume and outcomes but there are no UK data to support this or UK surgical guidelines. A multidisciplinary team representing the stakeholders in adrenal disease is preparing a national guidance on adrenal surgery. A review of the outcomes for adrenal surgery in England was performed to correlate outcomes with the volume of surgeon practice. Methods Hospital Episode Statistics ( HES ) data for the National Health Service ( NHS ) in England in the tax year 2013–2014 were examined for adrenal surgery. Length of hospital stay and rate of postoperative readmission were assessed as surrogate quality markers and a comparison made between ‘high‐’ and ‘low‐’ volume surgeons. Results A total of 795 adult adrenalectomies were performed by 222 different surgeons with a range of between 1 and 34 adrenalectomies performed per surgeon. Only thirty‐six (16%) adrenal surgeons performed 6 or more adrenalectomies. A total of 186 surgeons (84%) performed a median of one adrenalectomy a year. Length of stay and readmission rate within thirty days of operation was 60% longer and 47% higher, respectively, when performed by low‐volume surgeons. Conclusion The current provision of adrenal surgery in the UK is not in the best interests of patients and is not cost‐effective for the NHS . Adrenal surgery is best performed by higher volume surgeons in centres with dedicated adrenal multidisciplinary teams expert in all aspects of care of the adrenal patient.